What are Hammer Toes
A hammer toe is a bent or contracted lesser toe. The deformity can range from relatively simple to more complex.
A simple hammer toe primarily involves the toe itself, most commonly producing a bend in the middle joint of the toes. It may initially remain flexible but can become increasingly rigid over time.
A complex hammer toe also involves the metatarsophalangeal joint, where the toe connects to the forefoot. This may be associated with soft-tissue contracture, tendon imbalance, plantar plate injury, bony deformity, joint subluxation or dislocation. In these cases, the toe may become elevated, cross over an adjacent toe or lose contact with the ground.
Symptoms commonly result from pressure and friction rather than the shape of the toe alone. These may include:
A painful corn or skin irritation over the dorsal proximal interphalangeal joint
Rubbing or pressure between adjacent toes
Pain or callus at the tip of the toe
Pain beneath the metatarsophalangeal joint
Redness, blistering, ulceration or recurrent skin breakdown
Difficulty fitting or comfortably wearing footwear
Progressive elevation, rotation or crossing of the toe
What to expect from the Procedure and recovery
A procedure for hallux rigidus usually takes approximately 30–60 minutes in the operating theatre depending on the selected procedure.
Following surgery, patients are generally permitted to place some weight through the operated foot in a surgical sandal. This is considered protected or partial weight-bearing rather than normal, unrestricted walking. Crutches or another walking aid may be required during the early recovery period.
A bulky compression dressing and surgical sandal are usually worn for the first three to four weeks. The dressing helps protect the surgical site, support the corrected position and manage postoperative swelling. Once the wound has healed adequately and early bone healing is satisfactory, patients can generally transition into a wide, supportive sports shoe. This type of footwear may be required for approximately the next two months.
Return to sedentary work may be possible considerably earlier, whereas occupations involving prolonged standing, walking, lifting or safety footwear may require a longer period away from normal duties.
Swelling commonly persists for several months and may temporarily restrict footwear even after the bone has healed. Recovery time varies according to the procedure performed, bone healing, postoperative swelling, occupation and individual health factors. Progression of weight-bearing, footwear, driving, work and exercise should therefore be guided by clinical review and postoperative imaging rather than time alone.
When is Surgery Considered
Surgery may be considered when a hammer toe causes persistent pain, recurrent corns or wounds, difficulty wearing reasonable footwear, or restriction of normal activities despite appropriate non-surgical management.
Non-surgical treatment may include wider and deeper footwear, protective padding, toe sleeves, orthoses and management of associated forefoot pressure. These measures can accommodate the deformity and reduce irritation but generally do not permanently straighten a fixed hammer toe.
The appropriate operation depends on whether the deformity is flexible or rigid and whether instability is present at the metatarsophalangeal joint.
Outcomes from surgery
Generally, favourable outcomes. Hammer toes vary from simple flexible deformities to complex deformities involving the metatarsophalangeal joint, and a broad range of surgical procedures may therefore be required. Both open and minimally invasive techniques have demonstrated meaningful improvements in pain, alignment and function. A recent randomised study found comparable clinical outcomes between open and minimally invasive correction, with more than 92% of toes demonstrating satisfactory alignment and bone healing. Earlier comparative research also reported similar alignment and patient satisfaction, with fewer infections following percutaneous surgery. Outcomes depend on the complexity of the deformity and the procedure required, and the risks must be weighed against the expected benefits for each patient.
https://link.springer.com/article/10.1007/s00402-025-06114-1?utm
Example of a typical postoperative dressing and shoe
Example of soft tissue breakdown on the apex of the toe from a hammer toe deformity
Example of typical painful skin irritation from hammer toe deformity 2nd toe